Limits...
Invasive Fusariosis in the Voriconazole Era: Single-Center 13-Year Experience.

Stempel JM, Hammond SP, Sutton DA, Weiser LM, Marty FM - Open Forum Infect Dis (2015)

Bottom Line: We recorded patient characteristics including clinical presentation, treatment, and outcomes at 6 and 12 weeks after diagnosis, as well as species identification and antifungal drug susceptibilities.Conclusions.  Mortality associated with invasive fusariosis remains high.Cumulative mortality at our center was lower than previous reports despite elevated voriconazole minimum inhibitory concentrations.

View Article: PubMed Central - PubMed

Affiliation: Brigham and Women's Hospital ; Harvard Medical School.

ABSTRACT
Background.  Invasive fusariosis remains an aggressive, albeit infrequent infection in immunocompromised patients. Methods.  We identified all cases of invasive fusariosis between January 2002 and December 2014. We recorded patient characteristics including clinical presentation, treatment, and outcomes at 6 and 12 weeks after diagnosis, as well as species identification and antifungal drug susceptibilities. Results.  Fifteen patients were diagnosed with proven (12, 80%) or probable (3, 20%) fusariosis. Median age was 60 years (range, 26-78), and 10 patients were male. Underlying conditions included hematological malignancies (13, 87%), juvenile idiopathic arthritis (1, 7%), and third-degree burns (1, 7%). Five patients underwent hematopoietic stem-cell transplantation before diagnosis. Six patients (40%) received systemic glucocorticoids, and 11 patients (73%) had prolonged neutropenia at the time of diagnosis. Clinical presentations included the following: skin/soft tissue infection (8, 53%), febrile neutropenia (4, 27%), respiratory tract infection (2, 13%), and septic arthritis (1, 7%). Twelve patients were treated with voriconazole: 6 (40%) with voriconazole alone, 4 (27%) with voriconazole and terbinafine, and 2 (13%) with voriconazole, terbinafine, and amphotericin. One patient (7%) was treated with terbinafine alone, and another with micafungin alone. Four patients underwent surgical debridement (4, 27%). Susceptibility testing was performed on 9 isolates; 8 demonstrated voriconazole minimum inhibitory concentrations ≥4 µg/mL. The cumulative probability of survival was 66.7% and 53.3% at 6 and 12 weeks after diagnosis. Conclusions.  Mortality associated with invasive fusariosis remains high. Cumulative mortality at our center was lower than previous reports despite elevated voriconazole minimum inhibitory concentrations. Combination therapy should be studied systematically for fusariosis.

No MeSH data available.


Related in: MedlinePlus

Skin nodule, characteristic of disseminated invasive fusariosis.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4525012&req=5

OFV099F1: Skin nodule, characteristic of disseminated invasive fusariosis.

Mentions: Eight patients (53%) presented with skin lesions (local cutaneous or disseminated; see example in Figure 1), 4 (27%) with febrile neutropenia, 2 (13%) with respiratory symptoms, and 1 patient (7%) with septic arthritis of the knee. Disseminated fusariosis was confirmed in 8 patients (53%). Five patients had metastatic skin nodules, and 4 patients had positive blood cultures for Fusarium (1 patient had both disseminated skin nodules and fungemia).Figure 1.


Invasive Fusariosis in the Voriconazole Era: Single-Center 13-Year Experience.

Stempel JM, Hammond SP, Sutton DA, Weiser LM, Marty FM - Open Forum Infect Dis (2015)

Skin nodule, characteristic of disseminated invasive fusariosis.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4525012&req=5

OFV099F1: Skin nodule, characteristic of disseminated invasive fusariosis.
Mentions: Eight patients (53%) presented with skin lesions (local cutaneous or disseminated; see example in Figure 1), 4 (27%) with febrile neutropenia, 2 (13%) with respiratory symptoms, and 1 patient (7%) with septic arthritis of the knee. Disseminated fusariosis was confirmed in 8 patients (53%). Five patients had metastatic skin nodules, and 4 patients had positive blood cultures for Fusarium (1 patient had both disseminated skin nodules and fungemia).Figure 1.

Bottom Line: We recorded patient characteristics including clinical presentation, treatment, and outcomes at 6 and 12 weeks after diagnosis, as well as species identification and antifungal drug susceptibilities.Conclusions.  Mortality associated with invasive fusariosis remains high.Cumulative mortality at our center was lower than previous reports despite elevated voriconazole minimum inhibitory concentrations.

View Article: PubMed Central - PubMed

Affiliation: Brigham and Women's Hospital ; Harvard Medical School.

ABSTRACT
Background.  Invasive fusariosis remains an aggressive, albeit infrequent infection in immunocompromised patients. Methods.  We identified all cases of invasive fusariosis between January 2002 and December 2014. We recorded patient characteristics including clinical presentation, treatment, and outcomes at 6 and 12 weeks after diagnosis, as well as species identification and antifungal drug susceptibilities. Results.  Fifteen patients were diagnosed with proven (12, 80%) or probable (3, 20%) fusariosis. Median age was 60 years (range, 26-78), and 10 patients were male. Underlying conditions included hematological malignancies (13, 87%), juvenile idiopathic arthritis (1, 7%), and third-degree burns (1, 7%). Five patients underwent hematopoietic stem-cell transplantation before diagnosis. Six patients (40%) received systemic glucocorticoids, and 11 patients (73%) had prolonged neutropenia at the time of diagnosis. Clinical presentations included the following: skin/soft tissue infection (8, 53%), febrile neutropenia (4, 27%), respiratory tract infection (2, 13%), and septic arthritis (1, 7%). Twelve patients were treated with voriconazole: 6 (40%) with voriconazole alone, 4 (27%) with voriconazole and terbinafine, and 2 (13%) with voriconazole, terbinafine, and amphotericin. One patient (7%) was treated with terbinafine alone, and another with micafungin alone. Four patients underwent surgical debridement (4, 27%). Susceptibility testing was performed on 9 isolates; 8 demonstrated voriconazole minimum inhibitory concentrations ≥4 µg/mL. The cumulative probability of survival was 66.7% and 53.3% at 6 and 12 weeks after diagnosis. Conclusions.  Mortality associated with invasive fusariosis remains high. Cumulative mortality at our center was lower than previous reports despite elevated voriconazole minimum inhibitory concentrations. Combination therapy should be studied systematically for fusariosis.

No MeSH data available.


Related in: MedlinePlus